Healthy Hearts for Michigan (HH4M): Providing support to improve the heart health and help reduce CVD disparities by engagement with primary care practices.

项目摘要。心脏病发作和中风是美国两大死亡原因， 造成约80万人死亡，医疗保健和残疾成本超过3000亿美元， 年为了减轻这一负担，2011年，美国卫生与公众服务部推出了百万美元计划， 心脏运动，以防止一百万心脏病发作和中风，通过促进“ABCS”的临床 预防（阿司匹林治疗，血压控制，胆固醇管理和戒烟）。 密歇根州是美国心血管疾病（CVD）负担最高的10个州之一。的 疾病预防控制中心估计，密歇根州（MI）每10万人中有1,379人患有心血管疾病。大约35%的MI成人有 高血压（HTN），77%服用高血压药物，20%报告吸烟。 农村人口的HTN患病率高于平均水平， 不活跃，吸烟，糖尿病，与城市县相比。几乎25%的MI人口 生活在农村社区，在那里，人们经常需要长时间开车去他们的初级保健提供者， 供应商短缺。密歇根州的57个非大都市县都缺乏个人电脑的做法。 在AHRQ资助的EvidenceNOW计划中的工作表明，一些基于证据的QI策略， 改进CVD护理可以在资源有限的小型PC实践中进行调整和实施。健康 Hearts for Michigan（HH 4 M）项目将在EvidenceNOW的基础上建立一个全州范围的合作组织， MI的实践促进者网络，他们将支持小型农村实践实施临床干预措施， 改善HTN和戒烟，并提供ABCS证据教育。这些努力将与 通过远程医疗优化医疗IT和远程监测和管理， 农村医疗卫生服务短缺。我们召集了一个多学科的合作，包括 Altarum研究所，密歇根州农村健康中心，上半岛医疗保健解决方案，美国 医学协会，密歇根州卫生和人类服务部，西北大学和 医生顾问。我们的合作建立在Altarum和我们的MI合作伙伴之前的工作基础上， 通过从成功的EvidenceNOW中学习，为小型初级实践提供质量改进支持 计划传播以证据为基础的最佳做法，并建立可持续的初级保健推广服务， 密歇根 HH 4 M的具体目标是：（1）召集和评估全州合作社的发展， 支持HTN患者和吸烟患者在诊所内实施HH 4 M模式; 以及（2）通过确定以下内容，评估农村实践实施HH 4 M模式要素的能力 促进者和可持续实施的障碍，并测试该模型是否改善（a）血压 对照和（B）在具有一个试点和三个波的阶梯楔形试验中的烟草使用筛查和停止。

Project Abstract. Heart attack and stroke are two of the leading causes of death in the United States, accounting for approximately 800,000 deaths, and over $300 billion in healthcare and disability costs each year. To reduce this burden, in 2011, the U.S. Department of Health and Human Services launched the Million Hearts campaign to prevent one million heart attacks and strokes by promoting the "ABCS" of clinical prevention (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation). Michigan is among the top 10 states with the highest cardiovascular disease (CVD) burden in the US. The CDC estimates a CVD rate of 1,379 per 100K people in Michigan (MI). Approximately 35% of MI adults have hypertension (HTN), with 77% taking high blood pressure medication, and 20% reporting they were smoking. Rural populations experience a higher than average prevalence of HTN and are more likely to be physically inactive, use tobacco, and have diabetes, when compared with urban counties. Almost 25% of MI's population live in rural communities where individuals often face extended drive times to their primary care provider and provider shortages. Each of Michigan's 57 nonmetropolitan counties have a shortage of PC practices. Work within the AHRQ-funded EvidenceNOW program suggests that some evidence-based QI strategies to improve CVD care can be adapted and implemented in small PC practices with limited resources. The Healthy Hearts for Michigan (HH4M) project will build on EvidenceNOW by establishing a statewide cooperative and network of practice facilitators in MI who will support small rural practices to implement clinical interventions to improve HTN and tobacco cessation and provide education on ABCS evidence. These efforts will be coupled with optimization of health IT and remote monitoring and management through telehealth to address barriers to access and healthcare shortages in rural MI. We have convened a multi-disciplinary collaborative that includes Altarum Institute, Michigan Center for Rural Health, Upper Peninsula Healthcare Solutions, the American Medical Association, Michigan Department of Health and Human Services, Northwestern University and physician advisors. Our collaborative builds on the prior work of Altarum and our MI-based partners, delivering quality improvement support to small primary practices, with the learnings from a successful EvidenceNOW program to spread evidenced-based best practices and build a sustainable primary care extension service in Michigan. Specific Aims of HH4M are to: (1) convene and evaluate the development of a statewide cooperative to support the in-clinic implementation of the HH4M model for patients with HTN and patients who use tobacco; and (2) evaluate the ability of rural practices to implement the elements of the HH4M model by identifying facilitators and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation in a stepped-wedge trial with a pilot and three waves.